The most common problem related to the parathyroid glands is a condition called primary hyperparathyroidism. Many patients are first diagnosed with primary hyperparathyroidism when routine blood tests show abnormally high levels of calcium in the bloodstream. The diagnosis is confirmed when subsequent testing shows a high level of parathyroid hormone (PTH) in their blood.
The parathyroid glands are distinct glands located adjacent to the thyroid gland, though they have a very different function. When the endocrine system functions normally, the parathyroid glands, along with a hormone produced in the brain by the pituitary gland, regulate calcium levels by maintaining normal levels of calcium in the bloodstream even when oral intake of calcium in food or vitamins may be high or low. However, primary hyperparathyroidism occurs when one or more parathyroid glands become enlarged and independently produce excess PTH. In this situation, the bones, where calcium is stored, are stimulated to release excess calcium into the blood stream.
Primary hyperparathyroidism can lead to a number of medical issues and symptoms, including:
- Kidney stones
- Bone pain
- Osteoporosis (loss of bone mass)
- Mood disorders
Surgery is the definitive treatment for primary hyperparathyroidism.
The physician will first want to identify where the enlarged gland(s) are located in the neck through imaging studies. Most patients have one enlarged gland (adenoma), but some patients may have multiple enlarged glands (hyperplasia). Although the position of the parathyroid glands is relatively constant, on occasion these glands are sometimes located in unexpected areas in the neck. The studies usually include a nuclear medicine scan (sestamibi scan) and sometimes an ultrasound. These proactive measures often cut down on the time and extent of the surgery.
Some surgeons measure PTH levels during surgery as a means to confirm the success of surgery instantaneously. Our surgical team was one of the first in Boston to implement intraoperative PTH monitoring in our cases.
Parathyroid surgery is generally performed though a small incision in the front of the neck, with an excellent cosmetic result. Some patients stay overnight and some are discharged on the same day as surgery. Recovery is fairly quick, with most patients transitioning back to work and returning to their normal routines within a week.
Surgery is generally extremely successful as a permanent cure of primary hyperparathyroidism. Patients swallow and speak normally after the procedure. Ninety percent of patients who suffer from calcium-related kidney stones will never have another episode. Bone density will also improve over time after surgery. Many patients report that they “just feel better” and experience an improvement of mood and a feeling of overall well-being.